4-H SELF-DETERMINED PROJECT RECORD
					Year            	

Name  	     Age  	     Years in Project                          

The purpose of this form is to give you a tool to use to record information about your learning experience in this project. This form will provide one method of keeping track of basis expenses for this project. This record sheet is for you and your project leader to use.  Members are encouraged to complete this form and turn it in to their club organizational leader for feedback and/or to help the club reach their goal of completing their 4-H records as a club team.

1.	List your goals for this project this year. Complete this section at the beginning of the 4-H year when you enroll. Share these goals with your project leader and parent(s)/legal guardian(s). At the end of the year, place an “*” next to those that you accomplished.

For example:   I want to learn how to ....  	

I want to learn about ....   	

I want to increase my skill in ....  	

2.	List learning activities that relate to this project. Project meetings, field trips, workshops, judging schools, quiz bowels, skillathons, etc. Indicate level of participation: L-Club and Local, C/D-County/District, A-Area-wide, S or N-State or National

Activity/Event	L	C/D	A	S or N	

					

					

3.	List the demonstrations/talks/presentations you did related to this project.

Title	Topic	Event	#people	#times

	

4.	Project Expenses and Income

Project Costs
Date	Things bought, used, labor costs, value of homegrown product	Amount	

			
			
	**Beginning inventory (if applicable)		
	Total project expenses		

Project Income
Date	Things sold or used at home (tell which)	Amount	

			
	**Ending Inventory (if applicable)		
	Total project income		

Summary
Total project income	$  	

Total project expenses	$  	

How much money made or lost	$  	

*Beginning Inventory means what your project was worth in dollars at the start.
**Ending Inventory means what it was worth when you finished, if you didn’t sell or use it.

5.	List the knowledge/skills you learned and what you accomplished during the year.
For example: I learned how to ......	I interviewed 3 people about ....
I researched the different materials used in ....	I observed ....	I shared ....   I taught .

6.	List the size and amount accomplished in your project for this year. This is more than just how many items you entered at a fair or show. Include numbers: how many animals, articles, garments, pounds, repairs, hours spent making project, number of other people taught, total number of photos taken, etc. For example: Managed 12 breeding ewes for 8 months; Prepared 48 family meals; Repaired 12 articles of clothing for a cost savings of
$65.

7.	Project leadership activities (taking initiative, organizing, leading, teaching) in this project were: L-Club and Local, C/D-County/District, A-Area, S or N-State or National

Date	What You Did	Number of people/hours, etc	L	C/D	A	S or N	

							

8.	Citizenship activities (helping others, community service, volunteering) in this project were:
Date	Responsibility (your part)	Number people/hrs, etc.

9.	Value of my Leader/Helpers: List who helped you and what they did. What did you learn from each helper?

10.	Exhibits at shows and fairs. List items displayed or judged. L-Club and Local, C/D-County/District, A-Area, S or N-State or National

Item	Event	Placing	L	C/D	A	S or N	

							

11.	Reflection: Story or comments about these or other areas.
*	The favorite part of my project was ...  	

*	The part of my project that I am proud of is ...  	

*	The most difficult part of the project was ...  	

*	The most important thing I learned in this project was ...  	

12.	Apply - Next year I want to....  	

4-H Self-Determined STORY & PHOTOS
Attach a separate sheet of paper with a story telling why you chose this project, talk about experiences, challenges, successes, activities, etc...  May also include up to three (3) pages of photos.

This record has been reviewed by each of us:

Member’s Signature  	

Date  	

Project Leader Signature  	

Date  	

Kansas State University Agricultural Experiment Station and Cooperative Extension Service K-State Research and Extension is an equal opportunity provider and employer.
NOTE: adopted from state 4-H generic form